Disorders - Psychosis Disorders
Ly, A., Tremblay, G. A., Beauchamp, S.
Objectives Current service organization is not adapted for youth with or at risk of mental illness. Access, engagement and continuity of care are notorious challenges, particularly during transition from adolescence to adulthood, when youths are transferred to adult services. An HTA was initiated to evaluate the efficacy of programs for which admission is not a function of the legal age of majority.Methods A systematic review of systematic reviews identified literature published between 2000 and 2017 in 4 databases. To be selected, studies had to focus on specialised mental healthcare early intervention (EI) programs targeting both adolescents and young adults. Contextual and experiential data were collected through interviews with local leading experts. Article selection and quality assessment using ROBIS were conducted with inter rater agreement. The analytical framework developed includes 4 domains: access, engagement and continuity, recovery as well as meaningfulness and acceptability.Results 1841 references were identified. Following inclusion/exclusion criteria, 5 studies were selected, 3 of which focused on EI for psyschosis. EI programs alone do not seem to decrease duration of untreated psychosis. EI including a multi focus campaign were more successful. EI does, however, seem to decrease hospitalisation for psychosis. The experience of service users and professionals with inter agency collaboration and person-centred care models were analysed to identify facilitating and inhibiting implementation factors.Conclusions Healthcare policies need to support further research and development of EI where admission is not a function of the legal age of majority and diagnostic, particularly for youths at risk. Copyright © Cambridge University Press 2019.
International Journal of Technology Assessment in Health Care, 35(2) : 134-140
- Year: 2019
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
, Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Individual placement and support (IPS), vocational interventions
, Other service delivery and improvement interventions
Allott, K., McGorry, P. D., Yuen, H. P., Firth, J., Proffitt, T. M., Berger, G., Maruff, P., O'Regan, M. K., Papas, A., Stephens, T. C. B., O'Donnell, C. P.
Background: Elevated homocysteine is observed in schizophrenia and associated with illness severity. The aim of this study was to determine whether vitamins B12, B6, and folic acid lower homocysteine and improve symptomatology and neurocognition in first-episode psychosis. Whether baseline homocysteine, genetic variation, sex, and diagnosis interact with B-vitamin treatment on outcomes was also examined. Method(s): A randomized, double-blind, placebo-controlled trial was used. A total of 120 patients with first-episode psychosis were randomized to an adjunctive B-vitamin supplement (containing folic acid [5 mg], B12 [0.4 mg], and B6 [50 mg]) or placebo, taken once daily for 12 weeks. Coprimary outcomes were change in total symptomatology (Positive and Negative Syndrome Scale) and composite neurocognition. Secondary outcomes included additional measures of symptoms, neurocognition, functioning, tolerability, and safety. Result(s): B-vitamin supplementation reduced homocysteine levels (p = .003, effect size = -0.65). B-vitamin supplementation had no significant effects on Positive and Negative Syndrome Scale total (p = .749) or composite neurocognition (p = .785). There were no significant group differences in secondary symptom domains. A significant group difference in the attention/vigilance domain (p = .024, effect size = 0.49) showed that the B-vitamin group remained stable and the placebo group declined in performance. In addition, 14% of the sample had elevated baseline homocysteine levels, which was associated with greater improvements in one measure of attention/vigilance following B-vitamin supplementation. Being female and having affective psychosis was associated with improved neurocognition in select domains following B-vitamin supplementation. Genetic variation did not influence B-vitamin treatment response. Conclusion(s): While 12-week B-vitamin supplementation might not improve overall psychopathology and global neurocognition, it may have specific neuroprotective properties in attention/vigilance, particularly in patients with elevated homocysteine levels, patients with affective psychosis, and female patients. Results support a personalized medicine approach to vitamin supplementation in first-episode psychosis. Copyright © 2019 Society of Biological Psychiatry
Biological Psychiatry, 86(1) : 35-44
- Year: 2019
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Vitamins and supplements
Yamada, Y., Inagawa, T., Sueyoshi, K., Sugawara, N., Ueda, N., Omachi, Y., Hirabayashi, N., Matsumoto, M., Sumiyoshi, T.
Backgrounds: Social cognition deficits are a core feature of schizophrenia and deteriorate functionality of patients. However, evidence is sparse for the treatment effect on social cognition impairments in the early stage of psychosis. Here, we provide a systematic review of the literature on social cognitive impairment in early psychosis in relation to its intervention. Methods: A literature search was conducted on English articles identified by Web of Science and PubMed databases, according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Results: Five papers met the inclusion criteria.
Frontiers in psychiatry Frontiers Research Foundation, 10 : 333
- Year: 2019
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: First episode (psychosis only)
, Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Other biological interventions, Psychological Interventions (any)
, Cognitive remediation therapy
Palma, C., Farriols, N., Frias, A., Canete, J., Gomis, O., Fernandez, M., Alonso, I., Signo, S.
Aim: The main goal of this study was to evaluate the effectiveness of a cognitive motivational treatment program. Method(s): A randomized, controlled, single-blind clinical trial was carried out. A total of 104 patients were recruited to take part in the trial, of whom ultimately 62 patients were allocated into two groups and finished the study. An initial assessment was carried out before patients were randomly placed in one of two groups for the clinical trial: (a) PIPE program plus routine care; and (b) routine care only. Clinical assessments were performed at baseline at 6 months, 1 year and follow-ups, at 18 months and 5 years). Result(s): MANCOVA analysis of tests repeated 18 months after the start of the intervention detected significant differences between the two groups in terms of clinical variables, everyday functioning and relapses. These differences remained upon follow-up measurements taken five years after the start of the trial. Conclusion(s): The present study offers scientific evidence for cognitive-motivational therapy's effectiveness as a treatment for clinical symptoms in the early stages of psychosis. PIPE intervention may contribute to long-term clinical improvement and stability. Copyright © 2019
Psychiatry Research, 273 : 586-594
- Year: 2019
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Motivational interviewing, includes Motivational Enhancing Therapy, Other Psychological Interventions
Lutgens, D., Joober, R., Iyer, S., Lepage, M., Norman, R., Schmitz, N., Mustafa, S., Abadi, S., Malla, A.
BACKGROUND: Specialized early intervention (EI) following a first episode of psychosis (FEP) are effective at reducing negative symptoms, although its trajectory warrants systematic assessment. However, findings are equivocal as to whether extended gains are made post 2 years of EI and whether there is additional benefit of extending EI for an additional 3 years. METHOD(S): Data on 178 FEP patients, from a randomized controlled trial of a 3-year extension of EI service v. transfer to regular care following 2 years of EI service, were used for this report. Repeated measures analysis of variance were conducted separately for the initial 2 years of treatment in an EI service, and for the 3-year post-randomization to examine trajectories of negative symptoms over the two periods in the two arms of the study. RESULT(S): There were significant improvements in total negative symptoms over the first 2 years of EI F(4.612, 797.905) = 25.263, p < 0.001 and in domains of 'expressivity' and 'motivation'. In the following 3 years, there were further significant improvements in negative symptoms F(4.318, 759.908) = 4.182, p = 0.002 with no difference between groups F(4.318, 759.908) = 1.073, p = 0.371. Changes in negative symptoms over the extension period were driven by expressivity F(4.01, 674.73) = 7.19, p < 0.01, but not motivation F(6.58, 1112.18) = 0.95, p = 0.46. CONCLUSION(S): Negative symptoms improve significantly over the first 2 years of EI. Subsequent amelioration was largely the result of expressivity. Motivation deficits remained stable. Extended EI offered no advantage over regular care post-randomization.
Psychological Medicine, 49(1) : 66-74
- Year: 2019
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Biological Interventions (any)
, Complementary & Alternative Interventions (CAM)
, Service Delivery & Improvement, Psychological Interventions (any)
Robinson, D. G., Gallego, J. A., John, M., Hanna, L. A., Zhang, J.-P., Birnbaum, M. L., Greenberg, J., Naraine, M., Peters, B. D., McNamara, R. K., Malhotra, A. K., Szeszko, P. R.
Omega-3 treatment studies for multi-episode schizophrenia or clinical high risk for conversion to psychosis states have had variable, and often negative, results. To examine adjunctive omega-3 treatment for recent onset psychosis, participants aged 15-40 years with recent onset schizophrenia-spectrum (n = 46) or bipolar (n = 4) disorders and current psychotic symptoms were treated for 16 weeks with risperidone and randomly-assigned omega-3 (EPA 740 mg and DHA 400 mg daily) or matching placebo. The primary outcome measure was the Brief Psychiatric Rating Scale (BPRS) total score. Mean lifetime antipsychotic exposure was 18.1 days. Length of time in treatment, risperidone dose and number of omega-3/placebo capsules taken did not differ between conditions. Longitudinal analysis of the total BPRS score revealed a trend level (p = 0.0826) treatment effect favoring omega-3 treatment. Lorazepam was an allowed concomitant medication. Among the subgroup (N = 23) who did not receive lorazepam, the treatment effect on BPRS total scores favoring omega-3 was significant (p = 0.0406) and factor scores analyses revealed a substantial decrease in depression-anxiety with omega-3 but no change with placebo (treatment-by-time interaction, p = 0.0184). Motor side effects did not differ between conditions. Analysis of Systematic Assessment for Treatment Emergent Events assessments revealed fewer adverse events overall with omega-3 compared with placebo with the largest differences between conditions (all favoring omega-3) on confusion, anxiety, depression, irritability, and tiredness/fatigue. These results suggest that omega-3 adjuvant treatment is a potential option for depression and anxiety symptoms of people with recent onset psychosis. Further research is needed to confirm this potential. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Schizophrenia Research, 204 : 295-303
- Year: 2019
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Atypical Antipsychotics (second generation)
, Complementary & Alternative Interventions (CAM)
, Fish oil (Omega-3 fatty acids)
, Omega 3 fatty acids (e.g. fish oil, flax oil)
Rachamallu, V., Elberson, B. W., Vutam, E., Aligeti, M.
BACKGROUND: Clozapine is a second-generation antipsychotic typically used for refractory schizophrenia or otherwise psychotic pathology. There are no FDA or manufacturer guidelines for use of clozapine in pediatric population. We investigated the current state of research concerning the use of clozapine in pediatric patients.
AREAS OF UNCERTAINTY: We describe consistent calls for more research into the long-term and short-term effects of clozapine use in a young patient population. Despite the strongly supported efficacy, questions concerning clear indications for use and risk-benefit analysis persist. We acknowledge that a more comprehensive meta-analysis would greatly benefit the field. However, this is the first article of its kind for clozapine in recent history, and therefore, serves as a focus and reference point for future, more in-depth analyses.
DATA SOURCES: We conducted a search of PubMed, ClinicalKey, PsycINFO, and MEDLINE databases. Keywords used included, in varying combinations: clozapine, off-label, indications, children and adolescent, pediatric, behavioral, suicidality, psychosis, early and very-early onset schizophrenia, side-effect profile, and long-term use. Further criteria and selection are described in Methods below.
RESULTS: We describe the documented efficacy of clozapine for the management of refractory psychotic and nonpsychotic symptoms in the pediatric population. The authors highlight the risk of unmanaged early-onset schizophrenia, aggressive or suicidal behavior, and severe nonpsychotic pathology. Unfortunately, these studies are generally small. There is little consistency in when clozapine is prescribed, how long it is administered, and how long patients are followed. Despite the lack of FDA and manufacturer guidelines, clozapine continues to be used for the benefit of young patients.
CONCLUSIONS: Indications for prescription of clozapine should be revisited, given the data presented in this manuscript of a low risk-benefit ratio for properly chosen patients. Larger studies should be conducted to provide more statistical power and determine clear guidelines for use, risk of side effects, and long-term adverse events that may arise.
American Journal of Therapeutics, 26(3) : e406-e416
- Year: 2019
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Biological Interventions (any)
, Atypical Antipsychotics (second generation)
Usher, C., Thompson, A., Griebeler, M., Senders, A., Seibel, C., Ly, R., Murchison, C., Hagen, K., Afong, K. A., Bourdette, D., Ross, R., Borgatti, A., Shinto, L.
Aim: The primary aim was to demonstrate adherence to a novel 6-week lifestyle intervention program ("Meals, Mindfulness, & Moving Forward" [M3]) designed to help improve lifestyle practices of youth with a history of at least 1 psychotic episode. Method(s): M3 used a non-equivalent control group design involving clients from a community early intervention program. Seventeen individuals in the active M3 program and 16 controls were assessed for secondary outcomes at baseline, 6-weeks, and 12-weeks (6 weeks post-intervention) on cardiometabolic and symptomatic outcomes. Result(s): The program met its primary aim with 88% (15/17) of participants meeting adherence criteria. Compared with the controls, M3 participants showed significant improvement in positive psychotic symptoms (P =.002). Conclusion(s): This pilot study showed that young people involved in a community early intervention program adhered to an activity-based lifestyle program which included mindfulness meditation, yoga and nutrition education, warranting further evaluation with a larger sample size. Copyright © 2018 John Wiley & Sons Australia, Ltd
Early Intervention in Psychiatry, 13(1) : 147-150
- Year: 2019
- Problem: Psychosis Disorders
- Type: Controlled clinical trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Psychological Interventions (any)
, Mindfulness based therapy, Dietary advice, dietary change, Mind-body exercises (e.g. yoga, tai chi, qigong)
, Physical activity, exercise, Other complementary & alternative interventions
Becker, M., Correll, C. U., Galling, B.
Background: Schizophrenia is among the most debilitating disorders in the US [1], being associated with high disability [2], and enormous personal and societal cost [3]. Since people with early-phase schizophrenia generally respond better to treatment, the value of early optimized treatment has long been debated. Early Intervention Services (EIS) aim at both symptom reduction, improving functional outcomes, and reducing long-term disability during what has been called a "critical illness period". A recent meta-analysis (studies = 10, n = 2,176) comparing EIS versus treatment as usual (TAU) found that EIS outperformed TAU regarding all meta-analyzable outcomes [4]. However, the optimal EIS treatment duration and the question whether effects pertain after EIS discontinuation remain unclear. Aim(s): To determine the maintenance of effects after discontinuation of EIS vs TAU and to compare the continuation of EIS to step-down/ less intense maintenance treatment. Method(s): Systematic literature search of PubMed/MEDLINE/PsycInfo/clinicaltrials.gov until 04/01/2018 for (i) long-term follow-up data of randomized controlled trials comparing EIS and TAU in early psychosis, and (ii) randomized controlled trials comparing the continuation of EIS versus step-down/less intense maintenance treatment. Two independent investigators extracted data for a random effects meta-analysis. Result(s): Three trials followed patients after cessation of EIS (follow-up: EIS-patients = 59.6% (224/376); TAU -patients = 60.5% (221/365), without any significant EIS vs TAU group differences regarding individually reported outcomes. Moreover, meta-analyzable outcomes were non-significant, including >=1 psychiatric hospitalization (studies = 2, n = 592, EIS = 132/303, 43.6%; TAU = 138/289, 47.8%; RR = 0.87, 95%CI = 0.68-1.09, p = 0.226), number of hospitalizations (studies = 2, n = 144, SMD = 0.05, 95%CI = -0.34-0.45, p = 0.788), and number of bed days (studies = 3, n = 691, SMD = -0.08, 95%CI = -0.23-0.07, p = 0.282). These non-significant findings were in contrast to significant superiority of EIS in these same 2-3 studies at the end of the active EIS intervention. Three trials compared continuation of EIS to less intense maintenance treatment. One study found superiority of extended EIS for adherence, work alliance and patient satisfaction, while treatment effects remained stable in both groups, while another study found a significant effect of EIS on treatment duration and both positive and negative symptom remission. The third study indicated superiority of a 12 month-extended EIS for several outcomes, such as negative and depressive symptoms, general psychopathology, global functioning, independent living skills, and work productivity. As primary data of these studies are requested, meta-analytic calculations are expected to be available at the conference. Conclusion(s): Our results indicate that 9-24 months of EIS are insufficient to ensure maintenance effects of early intervention for early psychosis patients. Since only 3 studies collected data after EIS discontinuation, the non-significant findings could be due to insufficient power. However, pooled results at the end of active EIS of just these 2-3 studies yielded significant superiority for EIS, despite the low number of subjects/studies. Results of continued EIS vs step-down treatment clearly confirm the need for continuation of EIS. Sustaining gains achieved by EIS may very well be cost-effective, yet longer-term effects of EIS applied for >2 years need to be examined. Moreover, these findings question the common believe of a "critical period" for early interventions and guidelines focusing on continued treatment only for the first two years. Copyright © 2018
European Neuropsychopharmacology, 29 (Supplement 1) : S429
- Year: 2019
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Other service delivery and improvement interventions
Liu, Y., Yang, X., Gillespie, A., Guo, Z., Ma, Y., Chen, R., Li, Z.
The present study aimed to provide preliminary evaluation of the effectiveness of a brief CBT intervention focusing on relapse prevention and positive symptom in a Chinese first episode schizophrenia (FES) population. This randomized controlled trial recruited eighty outpatients with FES (as determined using the DSM-IV), aged 16-45 years, and on a current atypical antipsychotic. Patients were randomized to either 10 sessions of individual CBT (intervention group) adjunctive to treatment as usual (TAU) or TAU alone (control group). Outcome assessment of symptoms, relapse, hospitalization, insight and social functioning were administered at baseline and then post treatment (10 weeks), and at 6-month and 12-month follow ups. At 12 months, patients in the intervention group had significantly greater improvements in positive symptoms, general psychopathology and social functioning, as well as significantly lower rates of relapse, compared to the control group. Although patients in both groups demonstrated significantly improved negative symptom and insight scores from baseline, no group differences were found. This RCT demonstrates that FES patient can greatly benefit from CBT designed to target relapse prevention and positive symptom, with improvements sustained for 1 year following treatment.
Psychiatry Research, 272 : 275-283
- Year: 2019
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
, Relapse prevention
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Salgueiro, M., Segarra, R.
Long-acting injectable (LAI) antipsychotics could be a favorable option of treatment and have some advantages over oral medications. The aim of this study was to review the published data on the use of LAI formulation of second-generation antipsychotics (SGA) in first-episode psychosis (FEP). Using PubMed and Scopus databases, we performed a systematic literature search of articles published between 1 January 2000 and 30 April 2018, that reported clinical trials on the use of LAI SGAs in patients with FEP. Seventy-seven articles were considered eligible and full-text revised. Five studies fulfilled the inclusion criteria and evaluated the effect of LAI risperidone in FEP patients. Treatment with LAI SGAs was well accepted, and the majority of FEP patients agreed to change from an oral to an injectable formulation. At the 12-month follow-up, between 68 and 95% of FEP patients treated with LAI risperidone showed a good clinical response and 64% achieved remission of symptoms for at least 24 months of follow-up. Treatment with LAI SGAs can offer significant advantages over oral antipsychotics to FEP patients, especially to improve the adherence to medication and prevent the worsening of symptoms, the relapse, and rehospitalization associated with the discontinuation of treatment. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
International Clinical Psychopharmacology, 34(2) : 51-56
- Year: 2019
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Biological Interventions (any)
, Atypical Antipsychotics (second generation)
, Service Delivery & Improvement, Other service delivery and improvement interventions
Devoe, D. J., Farris, M. S., Townes, P., Addington, J.
Aim: Youth at clinical high risk (CHR) for psychosis often exhibit difficulties in social functioning and poorer social functioning may be predictive of transition to a psychotic disorder. Therefore, the primary objective of this systematic review was to summarize the impact of all interventions on social functioning in CHR samples. Method(s): Electronic databases PsycINFO, CINAHL, Embase, EBM, and MEDLINE were searched from 1951 to June 2017. Studies were selected if they included any intervention that reported changes in social functioning in youth at CHR. Data were evaluated using random effects pairwise meta-analyses, stratified by time, and reported as the standardized mean difference (SMD). Result(s): Nineteen studies met our inclusion criteria, including a total of 1513 CHR participants. The mean age was 20.5 years and 47% were male. Cognitive behavioural therapy (4 studies) did not significantly improve social functioning at 6 months (SMD = 0.06; 95% confidence interval [CI] = -0.35, 0.46), 12 months (SMD = -0.15; 95% CI = -0.38, 0.08) and 18 months (SMD = 0.20; 95% CI = -0.10, 0.50). Omega-3 (2 studies) did not significantly improve social functioning at 6 months (SMD = 0.01; 95% CI = -0.21, 0.24) and 12 months (SMD = -0.08; 95% CI = -0.33, 0.17). Lastly, cognitive remediation (3 studies) did not significantly improve social functioning at 2- to 3-month follow-up (SMD = 0.13, 95% CI = -0.18, 0.43). Conclusion(s): This systematic review and meta-analysis demonstrated that no treatment significantly improved social functioning in youth at CHR. Future randomized control trials are required that are designed to target and improve social functioning in youth at CHR for psychosis. Copyright © 2018 John Wiley & Sons Australia, Ltd
Early Intervention in Psychiatry, 13(2) : 169-180
- Year: 2019
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Cognitive remediation therapy, Fish oil (Omega-3 fatty acids)
, Omega 3 fatty acids (e.g. fish oil, flax oil)